Chairman’s introduction
This report opens with our mission: to protect, promote and maintain the health and safety of the public. The wording is new, and will be enshrined by an Act of Parliament later this year. The intent, however, is not new.
The past year has provided many opportunities to reflect on the Council’s fundamental purpose of public protection as the UK optical regulator.
We are the first healthcare regulator to have introduced student registration, ensuring that patients who come into contact with students as part of their training are afforded the same protection and assurances as they would have in any other clinical setting. Mandatory continuing education and training has further enhanced public confidence in the high standards of conduct and competence shown by the vast majority of eye care professionals. For the small minority of dispensing opticians and optometrists who fail to meet those standards, our new fitness to practise procedures ensure that both patients and professionals can expect timely and appropriate action.
Though it is conduct cases which grab the headlines, two of our most important roles as a regulator are setting standards and providing quality assurance for professional education. The GOC, together with the universities, colleges and partner bodies involved in providing optical education and assessment, has strengthened the competence-based framework which underpins modern
healthcare practice and delivery.
The GOC plays a key role
We cannot stand still, and this year we began the process of strategic planning to assess and manage our priorities over the next five years and beyond. Those challenges and priorities are highlighted throughout this report. The optical professions face unprecedented changes in models of healthcare delivery in general, and in commercial and clinical models for optical services in particular. The Council will play a key role in determining how the professions respond to the challenges and opportunities presented by an ageing population, the extension of prescribing roles and the growth of international markets for healthcare products and services, within the wider scope of our remit for public health and safety.
The GOC has welcomed the government’s review of non-medical regulation.
We highlighted opportunities to improve patient protection through more coordination and consistency between regulators, employers and other agencies involved in UK healthcare. Many of those suggestions have been included in the recommendations, which are now the subject of consultation.
I have been heartened by the effectiveness of the partnerships now in existence between the Council and the other optical and regulatory bodies, the Council for Healthcare Regulatory Excellence and the Department of Health, as well as the many voluntary and campaigning organisations that support and guide our work. Successful regulation is only possible through the genuine involvement of all our stakeholders. Last year saw the creation of a dedicated communications function, which will continue to build and enhance dialogue with our partners.
We welcome your views, and there is more information about how to contact us
in this report and on the Council’s website.
Rosie Varley
Chief executive’s report
The Chief Executive of a regulatory body cannot always expect to be a popular figure. The past year has highlighted perhaps more than most just what
a difficult balancing act is implied by the concept of professionally-led regulation.
Implementing changes to modernise the framework for optical regulation has demanded strength of purpose and flexibility of approach. We have had to
ensure that fundamental patient protection measures are not watered down
as they are put into practice, but avoid adding unnecessary bureaucracy or creating procedures which are unfair to optometrists and dispensing opticians.
Registration remains the most fundamental and tangible of our functions. New registration requirements, including compulsory professional indemnity insurance and criminal and health declarations, mean that patients can have even greater confidence in the integrity of their optometrist or dispensing optician. The strengthening of competence-based training and assessment in optometry and dispensing optics provides assurances that practitioners meet high standards before entering the registers. And mandatory continuing education and training has gone some way towards ensuring that everyone on the registers is up to date and fit to practise.
We have made real advances in modernising our investigation and adjudication procedures. In line with best practice, we have created an independent hearings panel and separated the management of hearings from investigation functions.
Our workload has increased significantly
All these measures have added significantly to an already substantial workload. Over the past year, we have made changes in the executive structure to ensure that we are able to continue to provide efficient and effective services to registrants, new applicants, partners and the public. We will continue to
increase our capacity to respond to the challenges ahead.
The government’s review of non-medical professional healthcare regulation is likely to lead to further reforms at a fundamental level. We must also adapt and respond to the challenges of devolution, managing the implications of diverging models for eye care across the four UK countries. And in an increasingly global market for healthcare services, we must look beyond UK boundaries to consider regulation in European and international contexts.
The Council’s success in meeting our objectives is only possible through the
hard work and dedication of our members, advisers, visitors and the staff team.
I was extremely pleased this year that the GOC’s commitment to developing
and rewarding our staff was acknowledged with the award of Investor in
People status.
We have the resources and the vision to face future challenges with confidence.
Peter Coe
Proportionate: Regulators should only intervene when necessary. Remedies should be appropriate to the risk posed, and costs identified and minimised.
We will identify and target the issues of greatest risk to public safety.
We will remove unnecessary bureaucracy.
Ensuring educational quality
One of the Council’s most important roles is setting the standards for entry to the optical professions. The GOC approves qualifications leading to registration which meet these standards, and carries out quality assurance visits to approved courses and examinations. In 2005/6, the Education Committee and its visitors participated in 60 quality assurance visits and meetings.
Modernising optical education and assessment
In 2005/6 UK optics started to see the results of the modernisation agenda for optical education which was started over 10 years ago.
Working in partnership with the UK optical education sector, the Council’s Education Committee has continued to implement a competence-based framework which reflects modern healthcare standards.
Core competencies required for entry to the two professions have been supplemented by the competencies required for entry to the specialist registers.
2006 will see the first optometry trainees complete the new scheme for registration instigated by the GOC and implemented by the College of Optometrists. Trainees receive ongoing assessment in the workplace against GOC defined competencies and a quarterly independent assessment by the College. The scheme culminates in a one day Final Assessment providing a ‘double check’ on the trainee’s safety to practise. The new format ensures better support and a more consistent experience for trainees throughout their pre-registration period.
Over the past year, the GOC has also been preparing for the introduction of significantly revised dispensing optics courses to be launched from September 2006. The courses and examinations will now specifically teach and examine the GOC competencies which reflect the work of the modern dispensing optician. The final assessment run by the Association of British Dispensing Opticians (ABDO) will require students to present a portfolio with a minimum number of case records in defined areas. These new arrangements will go some considerable way in preparing today’s trainees in dispensing optics for the challenges of the future,
not least in communication skills, paediatrics and low vision.
European and international optical education
Defining optical core competencies has enabled the GOC to be more proactive on
the European and international stage, whilst safeguarding standards for practice
in the UK.
In April 2006, the Council became the first European regulatory or licensing body to grant partial approval to the ECOO Diploma in Optometry. This significant development followed an extensive programme of work to ensure the Diploma met the UK standard for optometry. Recognition for the Diploma is a step towards a harmonised optometry profession in Europe, with patients benefiting from better access to services and with the assurance of high standards of practice from all optical professionals.
The GOC handbook for the approval of schemes of assessment of overseas qualified dispensing opticians and optometrists, published in June 2005, provides
a basis for considering other non-UK-based routes to registration.
Education challenges
To ensure systems for accrediting optical training and qualifications, and for continuing education, promote and maintain high standards and meet public health needs:
• Increase the rigour of CET and consider its contribution to any proposed system of revalidation
• Develop a career ladder/continuous programme of training in dispensing optics and optometry
• Enable free movement of professionals and students whilst maintaining quality standards
• Review public health priorities and promote optical education and training developments to meet current and future needs.
Table of visits
1 April 2005 – 31 March 2006
Sustaining competence
From 1 July 2005, Continuing Education and Training (CET) became a statutory requirement for continued registration.
The CET scheme exists to ensure registrants maintain the up-to-date knowledge and skills they need to practise safely throughout their career.
About the scheme
Registrants must gain 36 general points and 18 specialist points where relevant over a three year cycle. Points are recorded on the CET scheme website,
By December 2005, around 90% of GOC registrants had set up an account on cetoptics. Over 260 providers had registered, and submitted a total of 2,600 CET events for approval, representing a significant increase from the numbers of events offered previously under the voluntary schemes.
Approximately 3,300 approved CET events were run in 2005.
477,000 points were entered on cetoptics.com.
Developing the scheme
Registrants, optical bodies, CET providers and training and education providers participated in a consultation on the future of CET in October 2005. Nearly 500 individuals participated in an online survey which sought views on key policy issues raised by the CET Audit Group.
Changes suggested as part of the consultation have been incorporated in a
new set of CET Principles and Requirements and revised CET Rules, which will come into effect from 1 January 2007.
2005/6 in focus:
17 700 000 sight tests*
146 cases of concerns notified
to the GOC
30 registrants referred to
FTP Committee
7 registrants referred for
performance assessment
or review
3 interim orders for
suspension from
the register
1 registrant erased
from the register
Based on Department of Health figures for the year to 31 March 2005 of 11.7 million NHS sight tests, plus FODO estimate of 6 million eye tests paid for privately.
Accountable: Regulators must be able to justify decisions, and be subject to
public scrutiny. We will seek, and respond to, the views of stakeholders and partners.
We will consider and review the consequences of our actions.
Advancing practice
Much has changed since the original Opticians Act (1958) in the development of the optical professions and their scope of practice. Dispensing opticians and optometrists are increasingly moving into areas of specialised knowledge, skill and activity.
Specialist registers
On 30 June 2005 amendments to the Opticians Act gave the GOC the powers to establish three specialist registers. These recognise the advanced practice opportunities for dispensing opticians who wish to fit contact lenses and for optometrists to take on additional clinical responsibilities for prescribing medicines (additional supply and supplementary prescribing). To qualify as specialists, practitioners must undertake additional study and clinical practice.
Recognised specialties are now marked against a practitioner’s name in the register, providing a ready reference for the public and other health professionals.
The contact lens optician has been a recognised specialism for dispensing opticians since the introduction of the Contact Lens Qualifications Rules 1988. The GOC continues to monitor and visit the Contact Lens Certificate examination of the ABDO at five-yearly intervals. This examination provides a common standard for this specialism throughout the UK.
In 2005/06, the GOC approved the Therapeutics Common Final Assessment for optometrists, which is run by the College of Optometrists. Registrants who are eligible to enter this assessment have completed a GOC-approved course of study as either Additional Supply optometrists or optometrists who may
act as Supplementary Prescribers.
Independent prescribing of medicines
Following the extension of prescribing responsibilities to other healthcare professional groups, the Department of Health is consulting on plans to enable independent prescribing of medicines by optometrists from 2007. The GOC will play a key role informing and managing extensions to optometrists’ scope of practice to ensure public health benefits are realised safely.
Reinforcing standards
The new regulatory framework introduced in July 2005 is supported by core competencies and codes of conduct for the professions. The Standards Committee has continued to review and promote its guidance to the professions on standards of clinical performance, behaviour and ethics, and well as to monitor and advise on guidance issued by the professional and representative bodies.
Standards challenges
To ensure that standards for good practice and conduct are widely accepted, understood and followed by the eye care professions:
• Explore registration of the ‘eye team’
• Review the need for and, if appropriate, develop and consult
on a proposal for revalidation of registrants
• Ensure guidance reflects learning from Investigation and
FTP Committees and OCCS
• Work with optical bodies to harmonise codes of conduct
and guidance.
The changing face of optics
In less than 50 years since the introduction of statutory registration for optometrists, the profession has changed dramatically.
For the first time, in 2005, more than half of registered optometrists were female. Women are now in the majority in both professions, since female dispensing opticians overtook their male counterparts in 2003. To mark the occasion, we look back on the history of women in optics.
Early days
Whilst historical records do confirm a number of women spectacle-makers during the 1820-30s, it is probable that most women in optics started out as widows who inherited their late husbands’ business. Maryann Holmes, practising in London from around 1829, was one of these enterprising professionals and businesswomen. She would have made silver ‘wig’ spectacles for the affluent, fashionable London set, and possibly steel and tortoiseshell frames as they gained popularity in later years.
Exam success
In ophthalmic optics, one of the early pioneers was Miss Adaliza Dunscombe of Bristol. Just three years after the British Optical Association introduced its first examinations in ophthalmic optics in 1895, she became the first woman to sit and pass the exam, in February 1898.
As Miss Dunscombe entered the examination hall, she was one of the privileged few who could even consider gaining professional qualifications. At that time, only close female relatives of male Association members were eligible to sit the exams.
However, just after the turn of the century, the Association’s journal, The Dioptric and Ophthalmometric Review, dedicated an entire edition to women in optics. The review observed that, whilst just four practising optometrists were women, the number undertaking professional training was increasing rapidly.
Optics between the wars
By the outbreak of the First World War some 16 women were fully qualified ophthalmic opticians. The War changed social attitudes to women and work, and opened up new opportunities for women in many professions. In ophthalmic optics, this was coupled with reform of the exams system in 1923.
On the eve of World War Two, women were becoming a significant presence within the British Optical Association. Of three thousand members, there were 119 female practising members, a further 15 non-practising members, two dispensing associates and one student associate.
There were four other examining bodies for ophthalmic optics at that time and all
accepted women, putting optometry in the vanguard in promoting gender equality.
Professional regulation
Despite these early advances, on publication of the first Opticians Register in 1960, there were just 137 women dispensing opticians out of a total of 873 registrants. Women optometrists were an even smaller minority, with just 276 out of 6039 practitioners.
From the introduction of registration, numbers of women in optometry increased steadily, by one or two percentage points a year. By 1970, 9% of optometrists were women, and by 1980 that figure had doubled, to 18%. The next two decades saw similar increases. In 1990, they reached 35%, rising to 45% by 2000. And finally, 50% in 2005.
Women leaders
In recent years, women practitioners have taken on some of the most senior roles
in optics. The GOC currently has five women professional Council members, including Judith Morris, who is one of two female past presidents of the College
of Optometry. The Council also has a female lay Chairman, Rosie Varley.
Promoting diversity and opportunity
As the regulatory body, the Council has an important role to play in ensuring that optometry and dispensing optics continue to promote equality of opportunity for all groups, irrespective of age, gender or ethnic background. We work together with training institutions, professional bodies and employers to ensure that a diverse mix of practitioners is encouraged to enter and practise the professions. By providing opportunities for all groups to offer their knowledge and skills, both in the workplace and in developing and leading the professions, we can ensure that patients will continue to be able to access high quality eye care services now and into the future.